1. What is Secondary Traumatic Stress (STS)?
STS can result from indirect exposure to others’ traumatic experiences (e.g., learning or hearing about a client’s trauma history or investigating allegations of child abuse). This can be a natural consequence of working with individuals who have directly experienced trauma. STS symptoms mirror those of posttraumatic stress, such as intrusive thoughts/memories (e.g., the inability to stop thinking about an individual’s trauma history), avoidance (e.g., calling in sick more often to avoid work), and negative alterations in arousal, reactivity, cognitions, and mood (e.g., starting to view the world as an overly dangerous place or people as overly violent or untrustworthy; Molnar et al., 2017; Figley, 1995; Sprang et al., 2019).
2. What role does the organization play in addressing STS?
Organizations have a duty to address STS and support employees who are exposed to the traumatic experiences of others, as employees who are negatively impacted by their work may not be able to provide optimal care for others. Research using the Secondary Traumatic Stress Informed Organizational Assessment (STSI-OA), has found that increases in an organization’s adoption of STS informed policies and practices are associated with reductions in STS in employees (Sprang et al., 2021). Therefore, an organization’s efforts to become more STS-informed can positively impact their staff.
3. What is the purpose of the STSI-OA?
The purpose of the STSI-OA is to assess “an organization’s approach to STS prevention and intervention,” and “to develop a blueprint for how organizations can implement, or carry out, strategies to become more secondary traumatic stress informed” (Sprang et al., 2017, p. 3 & 5). Specifically, the STSI-OA measures employees’ perceptions of how STS informed their organization is, and also provides a comprehensive array of policies and practices that are recommended for organizations to address STS (Sprang et al., 2017).
4. Who developed the STSI-OA?
The STSI-OA was developed by a national group of experts in the field of STS, led by Dr. Ginny Sprang at the University of Kentucky Center on Trauma and Children (UK CTAC). This group drew from existing literature to identify primary domains of interest. Drafted items were then reviewed by national experts and the National Child Traumatic Stress Network’s STS Committee. Then, community reviewers from a range of systems of care (e.g., juvenile justice, child welfare, and community mental health) field tested the items and rated the tool on cultural sensitivity, readability, and utility. Feedback from field tests was used to modify the tool and create the final version of the STSI-OA (Sprang et al., 2017).
5. How is it being used?
The STSI-OA is used by organizations in a number of ways. One, to capture an initial or “baseline” assessment of how STS-informed employees perceive their organization to be. Two, to develop organizational goals for administrative, practice, and policy changes. These goals can be identified by reviewing STSI-OA items and domains for which the organization received lower scores, and then identifying what areas the organization has the current means to address. Three, to capture changes in how STS-informed an organization is, as a means of monitoring and assessing for the effectiveness of implementation strategies for improving STS policies and practices (Sprang et al., 2017). Organizations, municipalities, counties, states, and national and international organizations have used the STSI-OA to guide their organizational change towards becoming more STS-informed. Currently the STSI-OA has been downloaded for use all over the world.
6. What types of organizations should use the STSI-OA?
The STSI-OA can be used by any organization that serves trauma exposed populations. This includes, but is not limited to, organizations serving child welfare, community mental health, juvenile justice, education, health care, tribal settings, and/or first responders.
7. How long does it take to complete the assessment?
The STSI-OA takes an individual approximately 15-20 minutes to complete. If completing in a group allow extra time for discussion and consensus building.
8. Who should complete the STSI-OA?
The STSI-OA should be completed by staff at all levels of the organization, including senior leadership, front line staff, and administrative staff (including front-facing office staff). A cross-organizational approach, that includes multiple perspectives, provides the most robust assessment of the organization.
9. Is there a cost associated with using the STSI-OA?
The STSI-OA is available free of charge through the University of Kentucky Center on Trauma and Children and can be downloaded at https://ctac.uky.edu/stsi-oa following a brief registration process. If you need additional assistance in developing next steps, you can contact us for more information about consultation and technical assistance. Please do not replicate or adapt the tool without permission. You can contact Dr. Sprang at sprang@uky.edu to discuss any questions or issues related to the STSI-OA.
10. What is the best way to access the STSI-OA?
The best way to access the STSI-OA is through the University of Kentucky Center on Trauma and Children’s website: https://ctac.uky.edu/stsi-oa
11. What is the best way to administer the measure? (mention confidentiality)
- It is recommended that everyone in the organization complete the STSI-OA individually and that the results be averaged. It is important that confidentiality is protected, and that employees can respond to the items anonymously.
- If you have a small organization or team or prefer to complete the STSI-OA as a group, you may do so by coming to consensus on your answer to each question. You may use this website www.stsinformed.com for automatic scoring. The disadvantage to this method is that you may not get an accurate picture of how STS-informed your organization is if not everyone in the group agrees or doesn’t feel comfortable providing dissenting opinions.
- If you are completing the STSI-OA as part of a Breakthrough Series Collaborative, the UK CTAC team will provide you with a dashboard of results that are filtered and analyzed by organizational role and department or division (as long as the size of the unit is large enough to protect privacy). This way you can identify specific areas of need or strength. For more information on the STS Breakthrough Series Collaborative, register your interest here: https://ctac.uky.edu/form/sts-isc-initiatives-interest-for
12. Has the tool been validated and are there normed reference scores?
Yes, Sprang et al. (2017) described in detail the psychometric properties of the STSI-OA, and the validation of this tool. The standard form of the STSI-OA was described, that includes a Not Applicable (n/a) option. These response categories include 0 = n/a; 1= not at all; 2 = rarely; 3= somewhat; 4= mostly; and 5 = completely. Total scores range from 0 to 200, with higher scores indicating a higher level of competency in each area of activity. By a Factor Analysis, Sprang et al. (2017) also established normed reference scores and standard deviations (SD) for five global domains: Resilience Building, Promoting Safety, STS informed Policies, Leader Practices, Organizational Practices. For additional information about subscale and item level means see Rowland (2021) and Wilson (2020).
13. Is the tool available in other languages?
In addition to English, the STSI-OA is available in Spanish and French. There is also a Pandemic Version of the STSI-OA in English that specifically addresses how organizations can address pandemic conditions in their overall efforts to become STS-informed. All of these can be downloaded at https://ctac.uky.edu/stsi-oa
14. How do I score the STSI-OA?
The STSI-OA is scored by summing the value of the response to each item. This will allow you to have a score for each of the 5 domains, as well as a total score across all items. Automatic scoring based on group consensus is available at www.stsinformed.com
15. Once I get my scores, how do I know what to do next?
Examine the items your organization scored highest and lowest on, and prioritize your next steps accordingly. If you would like technical assistance in creating or executing a plan, please reach out to us for help with your next steps. Contact Dr. Sprang at sprang@uky.edu
16. Can the STSI-OA be reliably repeated?
Yes, the STSI-OA was designed to be repeated to track progress over time, and has very good test-retest reliability at 90 days (Sprang et al., 2017)
References
Figley, C. R. (1995). Systemic traumatization: Secondary traumatic stress disorder in family therapists. In Integrating family therapy: Handbook of family psychology and systems theory. (pp. 571-581). American Psychological Association.
Molnar, B., Sprang, G., , & Killian, K., Gottfried, R., Emery, V & Bride, B. (2017). Setting a Research Agenda for Advancing Science and Practice in the area of Vicarious Traumatization/Secondary Traumatic Stress, Traumatology, 23, 2, 129 -142. https://doi.org/10.1037/trm0000122
Rowland, Karen Loraine Hasie, "Policy Development: Stress Management and Critical Incident Debriefing" (2021). Digital Commons @ ACU, Electronic Theses and Dissertations. Paper 388.
Sprang, G. , Lei, F. & Bush, H. (2021). Can Organizational Efforts Lead to Less Secondary Traumatic Stress? A Longitudinal Investigation of Change. American Journal of Orthopsychiatry, 91 (4), 443-453. https://doi.org/10.1037/ort0000546
Sprang, G., Ford, J., Kerig, P., & Bride, B. (2019). Defining Secondary Traumatic Stress and Developing Targeted Assessments and Interventions: Lessons Learned from Research and Leading Experts, Traumatology, 25, 2, 72-81. https://doi.org/10.1037/trm0000180
Sprang, G., Ross, L., Miller, B. C., Blackshear, K., & Ascienzo, S. (2017). Psychometric properties of the Secondary Traumatic Stress–Informed Organizational Assessment. Traumatology, 23(2), 165 - 71 https://doi.org/10.1037/trm0000108.
Wilson, T. (2020). School Counselor and School Social Worker Professional Quality of Life and Secondary Trauma Informed Practices in Missouri High Schools (Doctoral dissertation, William Woods University).